Healthcare Provider Details

I. General information

NPI: 1386157741
Provider Name (Legal Business Name): SIDA HUANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 N STATE ROAD 7
PARKLAND FL
33073-3506
US

IV. Provider business mailing address

7501 N STATE ROAD 7
PARKLAND FL
33073-3506
US

V. Phone/Fax

Practice location:
  • Phone: 954-688-9993
  • Fax:
Mailing address:
  • Phone: 954-900-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22970
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: